| NPI | 1780672147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q7696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 36114153) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2016-07-05 |